How has the utilization of mobile stroke units changed the landscape of in-hospital stroke management?

Mobile stroke units shift CT-based diagnosis, thrombolysis, and LVO triage into the prehospital setting, enabling earlier hospital activation and direct-to-angiography workflows. In BEST-MSU, onset-to-thrombolysis fell from 108 to 72 minutes, treatment rates rose from 79.5% to 97.1%, and 90-day mRS 0-1 increased from 44.4% to 55.0%. Benefits for thrombectomy and hemorrhage outcomes remain less consistent. Similarly, high upfront cost, limited operating hours, specialized staffing requirements, and dispatch accuracy limit scalability to regions with high annual treatment volumes. Ultimately, the decisive factor is not the MSU alone, but whether the MSU, EMS system, receiving hospital, and stroke teams operate as one cohesive unit.